Nutrition
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Comparative Study
In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists.
After more than two decades of nutritional awareness, we designed a prospective study to determine whether malnutrition is still a significant issue in hospitalized patients. Patients admitted to an intensive care unit (ICU) were divided into well-nourished and malnourished groups, according to their nutritional status as assessed by serum albumin level and weight/height ratio. Severity of illness, as assessed by the Therapeutic Intervention Scoring System (TISS), was used to further stratify the study population. ⋯ In patients with less severe degrees of illness, the existence of malnutrition led to a worse outcome than in sicker patients. To further assess the clinical setting in which hospital-related malnutrition develops or is exacerbated, postoperative patients admitted to the ICU (n = 66) were also studied in a nutritional survey; the results of this survey indicate that: (a) the incidence of malnutrition in the surgical population is similar to that in the whole study population, and (b) hospital-related malnutrition in surgical patients mainly develops during their preoperative stay in general wards. Whereas our conclusion that patients' outcome is adversely affected by a poor nutritional status is not new or startling, malnutrition continues to be a persistent problem in hospitalized patients, which can be readily identified using simple and easily available indices and, furthermore, readily treated.
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Several aspects on the effect of nutrients on small intestinal motility are not completely understood. We have analyzed changes of motor activity of the canine small bowel following intragastric administration of casein and soy protein. ⋯ Casein was followed by a statistically significant decrease of amplitude and frequency of small intestinal contractions, compared to soy protein. Pretreatment with naloxone suppressed the inhibitory effect of casein, suggesting that stimulation of opioid receptors by beta casomorphins, a product of digestion of casein, might be involved in the motility changes observed.
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Cytokines are produced in disease or during immunologic challenge. Some cytokines increase host resistance to disease whereas others trigger inflammatory processes. Interleukin 1 (IL-1) and tumor necrosis factor (TNF) are pro-inflammatory cytokines that affect nearly every cell either alone or in a synergistic fashion. ⋯ It is unclear whether these endogenous levels are sufficient to block IL-1 and TNF from triggering their respective cell-bound receptors in disease. IL-1 infusions into patients induce circulating levels of IL-1ra but not IL-1. TNF infusions into patients also induce high levels of soluble TNF receptors.
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Editorial Comment
Assessment of the operative risk: a challenge for the surgeon.